CHRONIC VIRAL HEPATITIS C MICRO-ELIMINATION PROGRAM USING TELEMEDICINE. THE MEXICAN EXPERIENCE.

BACKGROUND Infection with hepatitis C virus (HCV) is a global health problem; chronic infection induces the development of fibrosis and cirrhosis together with all their related complications. The use of direct-acting antiviral (DAA) drugs has proven highly effective. Telemedicine is a present-day resource that brings treatment closer to distant areas and may result in savings. OBJECTIVE To implement a microelimination program for HCV using DAAs with support from a telemedicine program to minimize expenses. PATIENTS AND METHODS The program was developed at the Medical Services department of Petroleos Mexicanos (SMPM) with national coverage; patients diagnosed with chronic hepatitis C were included. These were classified into locals and outsiders. Treatment for foreign patients was indicated, monitored, and completed through telemedicine, thus avoiding their transport to the country's capital city, in order to save up on transportation costs and travel allowances. RESULTS A total of 136 patients, 74 locals and 62 outsiders participated. Transfer was avoided for 62 patients (45.5 %), which meant that telemedicine resulted in USD 3,176.20 savings per patient, with overall savings of USD 196,924,40 from cost minimization. A total of 30 patients remained untreated for lack of medication, hence coverage amounted to 86 %. Sustained virological response (SVR) was achieved in 99% of cases. Only 2 patients had treatment failure. Adverse events included headache and fatigue in 5 % of the sample. CONCLUSIONS With the aid of a telemedicine approach significant savings were achieved by minimizing costs, since nearly half of patients were outsiders. Coverage reached 86 %. Treatment with DAAs was successful for 99 % of our cases.